Multimorbidity, Depression, and Mortality in Primary Care: Randomized Clinical Trial of an Evidence-Based Depression Care Management Program on Mortality Risk
Multimorbidity, Depression, and Mortality in Primary Care: Randomized Clinical Trial of an Evidence-Based Depression Care Management Program on Mortality Risk
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DOI：
10.1007/s11606-015-3524-y
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发表时间：
2016-04-01
影响因子：
5.7
通讯作者：
Reynolds, Charles F.
中科院分区：
文献类型：
--
作者：
Gallo, Joseph J.;Hwang, Seungyoung;Reynolds, Charles F.
三分之二的老年人有两个或两个以上的医疗条件，往往优先于抑郁症在初级care.We评估是否循证抑郁症护理管理将改善老年人的长期死亡率风险与医疗comorhabilitation.Longitudinal分析实践随机预防自杀在初级保健老年人：合作试验（前景）。20个初级保健实践随机分为干预或常规护理。样本包括1204名老年初级保健患者，他们在基线时完成了Charlson Comorbid Index（CCI）和其他访谈问题。两年来，抑郁症护理经理与初级保健医生合作，为抑郁症提供基于算法的护理，提供心理治疗，如果有必要，增加抗抑郁剂剂量，并监测症状，基于临床访谈的抑郁状态，CCI评估医学合并症，以及8年时的生命状态（国家死亡指数）。在通常的护理条件下，患有最高水平的医学合并症和抑郁症的患者在以下过程中死亡风险增加-与有最小医疗合并症的抑郁症患者相比[风险比3.02（95%CI，1.32至8.72）]。相比之下，在干预实践中，与具有最小医学合并症的抑郁症患者相比，具有最高医学合并症和抑郁症水平的患者的风险并未显著增加[风险比1.73（95% CI，0.86至3.96）]。非抑郁症患者在干预和常规护理实践中有相似的死亡风险。抑郁症管理减轻了多重抑郁症和抑郁症对死亡率的联合作用。抑郁症管理应该是最佳患者护理的组成部分，而不是次要焦点。
Two-thirds of older adults have two or more medical conditions that often take precedence over depression in primary care.We evaluated whether evidence-based depression care management would improve the long-term mortality risk among older adults with increasing levels of medical comorbidity.Longitudinal analyses of the practice-randomized Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT). Twenty primary care practices randomized to intervention or usual care.The sample included 1204 older primary care patients completing the Charlson Comorbidity Index (CCI) and other interview questions at baseline.For 2 years, a depression care manager worked with primary care physicians to provide algorithm-based care for depression, offering psychotherapy, increasing the antidepressant dose if indicated, and monitoring symptoms, medication adverse effects, and treatment adherence.Depression status based on clinical interview, CCI to evaluate medical comorbidity, and vital status at 8 years (National Death Index).In the usual care condition, patients with the highest levels of medical comorbidity and depression were at increased risk of mortality over the course of the follow-up compared to depressed patients with minimal medical comorbidity [hazard ratio 3.02 (95 % CI, 1.32 to 8.72)]. In contrast, in intervention practices, patients with the highest level of medical comorbidity and depression compared to depressed patients with minimal medical comorbidity were not at significantly increased risk [hazard ratio 1.73 (95 % CI, 0.86 to 3.96)]. Nondepressed patients in intervention and usual care practices had similar mortality risk.Depression management mitigated the combined effect of multimorbidity and depression on mortality. Depression management should be integral to optimal patient care, not a secondary focus.